NCLEX National Council Licensure Examination - -RN NCLEX-RN Dumps in PDF

Free NCLEX NCLEX-RN Real Questions (page: 15)

To ensure proper client education, the nurse should teach the client taking SL nitroglycerin to expect which of the following responses with administration?

  1. Stinging, burning when placed under the tongue
  2. Temporary blurring of vision
  3. Generalized urticaria with prolonged use
  4. Urinary frequency

Answer(s): A

Explanation:

(A) Stinging or burning when nitroglycerin is placed under the tongue is to be expected. This effect indicates that the medication is potent and effective for use. Failure to have this response means that the client needs to get a new bottle of nitroglycerin. (B, C, D) The other responses are not expected in this situation and are not even side effects.



To ensure proper client education, the nurse should teach the client taking SL nitroglycerin to expect which of the following responses with administration?

  1. Stinging, burning when placed under the tongue
  2. Temporary blurring of vision
  3. Generalized urticaria with prolonged use
  4. Urinary frequency

Answer(s): A

Explanation:

(A) Stinging or burning when nitroglycerin is placed under the tongue is to be expected. This effect indicates that the medication is potent and effective for use. Failure to have this response means that the client needs to get a new bottle of nitroglycerin. (B, C, D) The other responses are not expected in this situation and are not even side effects.



The usual treatment for diabetes insipidus is with IM or SC injection of vasopressin tannate in oil. Nursing care related to the client receiving IM vasopressin tannate would include:

  1. Weigh once a week and report to the physician any weight gain of10 lb.
  2. Limit fluid intake to 500 mL/day.
  3. Store the medication in a refrigerator and allow to stand at room temperature for 30 minutes prior to administration.
  4. Hold the vial under warm water for 10­15 minutes and shake vigorously before drawing medication into the syringe.

Answer(s): D

Explanation:

(A) Weight should be obtained daily. (B) Fluid is not restricted but is given according to urine output. (C) The medication does not have to be stored in a refrigerator. (D) Holding the vial under warm water for 10­15 minutes or rolling between your hands and shaking vigorously before drawing medication into the syringe activates the medication in the oil solution.



The usual treatment for diabetes insipidus is with IM or SC injection of vasopressin tannate in oil. Nursing care related to the client receiving IM vasopressin tannate would include:

  1. Weigh once a week and report to the physician any weight gain of10 lb.
  2. Limit fluid intake to 500 mL/day.
  3. Store the medication in a refrigerator and allow to stand at room temperature for 30 minutes prior to administration.
  4. Hold the vial under warm water for 10­15 minutes and shake vigorously before drawing medication into the syringe.

Answer(s): D

Explanation:

(A) Weight should be obtained daily. (B) Fluid is not restricted but is given according to urine output. (C) The medication does not have to be stored in a refrigerator. (D) Holding the vial under warm water for 10­15 minutes or rolling between your hands and shaking vigorously before drawing medication into the syringe activates the medication in the oil solution.



The predominant purpose of the first Apgar scoring of a newborn is to:

  1. Determine gross abnormal motor function
  2. Obtain a baseline for comparison with the infant's future adaptation to the environment
  3. Evaluate the infant's vital functions
  4. Determine the extent of congenital malformations

Answer(s): C

Explanation:

(A) Apgar scores are not related to the infant's care, but to the infant's physical condition. (B) Apgar scores assess the current physical condition of the infant and are not related to future environmental adaptation. (C) The purpose of the Apgar system is to evaluate the physical condition of the newborn at birth and to determine if there is an immediate need for resuscitation. (D) Congenital malformations are not one of the areas assessed with Apgar scores.



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